The Cardiometabolic Benefits of Routine Physical Activity in Persons Living with Spinal Cord Injury
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PHYSICAL ACTIVITY (DER WARBURTON, SECTION EDITOR)
The Cardiometabolic Benefits of Routine Physical Activity in Persons Living with Spinal Cord Injury Jonathan Myers & B. Jenny Kiratli & Jeffrey Jaramillo
Published online: 5 May 2012 # Springer Science+Business Media, LLC (outside the USA) 2012
Abstract Health concerns related to aging have begun to play a greater role in the management of persons with spinal cord injury (SCI). A particular concern that has emerged is cardiovascular disease (CVD); for long-term SCI, morbidity and mortality from CVD now exceeds that due to renal and pulmonary conditions. Physical inactivity is a major risk factor for CVD, and this risk factor is particularly high in SCI. Physical activity in SCI is limited not only by the obvious physical barriers but also by availability of facilities and transportation, psychosocial barriers, and comorbidities. Structured programs of physical activity have been demonstrated to be beneficial for improving exercise capacity and reducing particular CVD risk factors in SCI, but there is inconsistency among the available studies. This article reviews the prevalence of CVD and associated cardiometabolic risk markers in SCI, and describes the available evidence supporting the benefits of physical activity in persons with SCI. Keywords Spinal cord injury . Cardiovascular disease . Metabolic syndrome . Physical activity . Exercise capacity . Obesity, cardiometabolic risk . Insulin resistance J. Myers (*) Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Stanford University, Cardiology 111C, 3801 Miranda Ave, Palo Alto, CA 94304, USA e-mail: [email protected]
B. J. Kiratli : J. Jaramillo Spinal Cord Injury Center, Veterans Affairs Palo Alto Health Care System, Stanford University, Cardiology 111C, 3801 Miranda Ave, Palo Alto, CA 94304, USA B. J. Kiratli e-mail: [email protected] J. Jaramillo e-mail: [email protected]
Introduction The annual incidence of spinal cord injury (SCI) is approximately 12,000 per year [1]. SCI is a major cause of disability and is accompanied by enormous health-care costs. While marked improvements in the treatment and survival of persons with SCI have occurred in recent decades, the mortality rate for this condition remains higher in those with SCI than in age-matched populations without SCI [1–3]. Historically, respiratory and renal conditions have been the most prevalent underlying illnesses in the SCI population, and despite reductions in their incidence they remain frequent causes of mortality. However, as life expectancy has increased following SCI, aging-related conditions have become more important as determinants of survival. Recent data suggest that cardiovascular disease (CVD) has become a leading cause of mortality in chronic SCI [2]. Morbidity from cardiovascular causes, particularly coronary artery disease, occurs more often and earlier in the lifespan of persons with SCI than of those without SCI [1, 3–5]. Major contributors to this heightened risk in SCI include a higher prevalence of h
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